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El-Qushayri AE, Reda A. Surgical versus interventional coronary revascularization in kidney transplant recipients: a systematic review and meta-analysis. Int Urol Nephrol 2023; 55:2493-2499. [PMID: 36906876 PMCID: PMC10499735 DOI: 10.1007/s11255-023-03546-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/02/2023] [Indexed: 03/13/2023]
Abstract
AIM To study the most beneficial coronary revascularization strategy in kidney transplant recipients (KTR). METHODS In 16th June 2022 and updated on 26th February 2023, we searched in five databases including PubMed for relevant articles. The odds ratio (OR) together with the 95% confidence interval (95%CI) were used to report the results. RESULTS Percutaneous coronary intervention (PCI) was significantly associated with significant lower in-hospital mortality (OR 0.62; 95%CI 0.51-0.75) and 1-year mortality (OR 0.81; 95%CI 0.68-0.97), but not overall mortality (mortality at the last follow-up point) (OR 1.05; 95%CI 0.93-1.18) rather than coronary artery bypass graft (CABG). Moreover, PCI was significantly associated with lower acute kidney injury prevalence (OR 0.33; 95%CI 0.13-0.84) compared to CABG. One study indicated that non-fatal graft failure prevalence did not differ between the PCI and the CABG group until 3 years of follow up. Moreover, one study demonstrated a short hospital length of stay in the PCI group rather than the CABG group. CONCLUSION Current evidence indicated the superiority of PCI than CABG as a coronary revascularization procedure in short- but not long-term outcomes in KTR. We recommend further randomized clinical trials for demonstrating the best therapeutic modality for coronary revascularization in KTR.
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Affiliation(s)
| | - Abdullah Reda
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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2
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Lang J, Buettner S, Weiler H, Papadopoulos N, Geiger H, Hauser I, Vasa-Nicotera M, Zeiher A, Fichtlscherer S, Honold J. Comparison of interventional and surgical myocardial revascularization in kidney transplant recipients - A single-centre retrospective analysis. IJC HEART & VASCULATURE 2018; 21:96-102. [PMID: 30426068 PMCID: PMC6224329 DOI: 10.1016/j.ijcha.2018.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 10/19/2018] [Accepted: 10/24/2018] [Indexed: 01/22/2023]
Abstract
Background Kidney transplant recipients (KTR) reflect a high-risk population for coronary artery disease (CAD). CAD is the most common cause for morbidity and mortality in this population. However, only few data are available on the favourable revascularization strategy for these patients as they were often excluded from studies and not mentioned in guidelines. Methods This retrospective single-centre study includes patients with a history of kidney transplantation undergoing myocardial revascularization for multivessel or left main CAD by either percutaneous coronary intervention (PCI, n = 27 patients) or coronary artery bypass grafting (CABG, n = 24 patients) at University Hospital Frankfurt, Germany, between 2005 and 2015. Results In-hospital mortality was higher in the CABG group (20.8% vs. 14.8% PCI group; p = 0.45). In Kaplan-Meier analysis, one-year-survival showed better outcome in the PCI group (85.2% vs. 75%). After four years, outcome was comparable between both strategies (PCI 66.5% vs. CABG 70.8%; log-rank p = 0.94). Acute kidney injury (AKI), classified by Acute Kidney Injury Network, was observed more frequently after CABG (58.3% vs. 18.5%; p < 0.01). After one year, graft survival was 95.7% in the PCI group and 94.1% in the CABG group. Four year follow-up showed comparable graft survival in both groups (76.8% PCI and 77.0% CABG; p = 0.78). Conclusion In this retrospective single-centre study of KTR requiring myocardial revascularization, PCI seems to be superior to CABG with regard to in-hospital mortality, acute kidney injury and one-year-survival. To optimise treatment of these high-risk patients, larger-scaled studies are urgently warranted.
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Affiliation(s)
- Jeannine Lang
- Department of Internal Medicine III, Division of Cardiology and Nephrology, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,Division of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Stefan Buettner
- Department of Internal Medicine III, Division of Cardiology and Nephrology, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,Division of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Helge Weiler
- Department of Internal Medicine III, Division of Cardiology and Nephrology, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,Division of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Nestoras Papadopoulos
- Department of Internal Medicine III, Division of Cardiology and Nephrology, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,Division of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Helmut Geiger
- Department of Internal Medicine III, Division of Cardiology and Nephrology, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,Division of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Ingeborg Hauser
- Department of Internal Medicine III, Division of Cardiology and Nephrology, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,Division of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Mariuca Vasa-Nicotera
- Department of Internal Medicine III, Division of Cardiology and Nephrology, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,Division of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Andreas Zeiher
- Department of Internal Medicine III, Division of Cardiology and Nephrology, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,Division of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Stephan Fichtlscherer
- Department of Internal Medicine III, Division of Cardiology and Nephrology, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,Division of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Joerg Honold
- Department of Internal Medicine III, Division of Cardiology and Nephrology, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,Division of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Drug-Eluting Stents Versus Bare Metal Stents for Percutaneous Coronary Intervention in Kidney Transplant Recipients. Transplantation 2017; 101:851-857. [PMID: 27517730 DOI: 10.1097/tp.0000000000001446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The comparative effectiveness of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus bare metal stents (BMS) has not been studied in the kidney transplant population. METHODS Using the US Renal Data System, we identified 3245 kidney transplant patients who underwent PCI between April 2003 and December 2010; 2400 and 845 patients received DES and BMS, respectively. We used propensity score matching and inverse probability of treatment weighting to create DES- and BMS-treated groups whose observed baseline characteristics were well-balanced. The associations between stent type and the outcomes of (1) death; (2) death or myocardial infarction (MI); (3) death, MI, or repeat revascularization (RR); and (4) hospitalized bleeding were compared using Cox proportional hazards regression. RESULTS Drug-eluting stent use increased during the study period, mirroring the trend described in the general population. In the propensity score-matched cohort, no significant association among DES (vs BMS) use and outcomes was observed at 1 and 2 years of follow-up. However, at 3 years, DES was associated with 20% (95% confidence interval [CI], 4-33%) lower risk of death, 15% (95% CI, 1-27%) lower risk of death or MI, and 14% (95% CI, 2-24%) lower risk of death, MI, or repeat revascularization. There were no significant differences in rates of hospitalized bleeding at any time point. Results were similar in the inverse probability of treatment weighting analysis. CONCLUSIONS In this retrospective study of US kidney transplant recipients undergoing PCI, DES was associated with better clinical outcomes beyond 2 years of follow-up.
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Zerillo J, Kim S, Hill B, DeMaria S, Sakai T. Noteworthy Literature Published in 2016 for Abdominal Organ Transplant Anesthesiologists. Semin Cardiothorac Vasc Anesth 2017; 21:70-80. [PMID: 28107792 DOI: 10.1177/1089253216688538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
More than 400 peer-reviewed publications on the topic of pancreas transplantation, more than 400 on intestine transplantation, and more than 3000 on renal transplantation were published in 2016. This review will highlight the most pertinent literature for anesthesiologists caring for patients undergoing non-liver abdominal organ transplantation. This review is the second part in an annual series to review relevant contributions in the field of abdominal organ transplantation focusing on pancreas, intestine, and renal transplantation. We explore a myriad of topics, including outcomes determined by center size, novel assessment of intestine graft function, the effect of Zika virus on the transplant population, appropriate fluid management for renal transplantation, cardiovascular risk assessment in the transplant population, and several topics pertinent to optimizing patient and graft survival.
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Affiliation(s)
- Jeron Zerillo
- 1 Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sang Kim
- 1 Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bryan Hill
- 1 Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel DeMaria
- 1 Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tetsuro Sakai
- 2 University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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